Allen, Otis George

Allen, Otis George is an individual health care provider with primary practice located at 1215 Holiday Dr , Bloomington IL 61704-2214. He recently has only one registered license in Allopathic & Osteopathic Physicians / Plastic Surgery, which is considered as his primary health care specialty. Allen, Otis George can be contacted via phone (309) 827-3881.

Contact Information

Primary practice address
1215 Holiday Dr Bloomington IL 61704-2214
Phone: (309) 827-3881
Fax: (309) 661-0234
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Plastic Surgery 208200000X 036064804 Illinois

Profile Details

NPI number 1306847900
LBN Legal business name Allen, Otis George
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 3rd, 2005
Last updated Aug 17th, 2016 - about 10 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1306847900 NPPES
Illinois MEDICAID 036064804

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